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1st Feb


Physical Therapy Rehabilitation for Joint Hypermobility

Joint hypermobility, also referred to as excessive joint laxity, refers to joints which have an abnormally large amount of range of motion. This can occur locally at select joints from traumas or long term repeated mechanical strain to an area, or it could exist in many joints or throughout the body due to genetic factors, or certain connective tissue disorders. The joint laxity is caused by loose ligaments and joint capsules, and not by extremely flexible muscles, although both can certainly co-exist, such as in many dancers and gymnasts.

Joint hypermobility may or may not cause any symptoms. The highly conditioned athlete or dancer may have exceptional strength and coordination of movements throughout their considerable range, thereby controlling the movements and preventing compromise of any joint tissues. However, the less conditioned person, or the injured athlete, will not have this ability, and therefore pain and tissue irritation may arise from ligaments and capsules being stretched too far, or from soft tissues getting entrapped in the joint, or impinged. This may even cause certain joints to lock up, such as in the neck or back, as the painful tissues cause the stabilizing spinal muscles to go into spasm or guarding.

The person who has pain from joint hypermobility often feels better by constantly changing positions and moving around, but prolonged static positions may be painful and fatiguing. The shoulder is susceptible to injury in the hypermobile individual, since it is naturally the most mobile joint in our body. This can lead to subluxation of the joint (joint temporarily moves out of its normal position) or even dislocation, where it stays out of joint until it is put back in. Traumas can make other joints unstable as well, such as the patella and knee, ankle and spinal joints.

Fortunately, unless there is very severe hypermobility present, specific rehabilitation can minimize or eliminate pain from this condition. The skilled manual physical therapist will first assess exactly how much each joint moves in different directions, and grade the amount of mobility present. It is common to find areas of reduced mobility nearby, called hypomobility, which must be treated with specific mobilization or manipulation treatment before treatment of the hypermobile joint can be successful.

Stability of joints is primarily created by nerve endings in the joint capsule sending impulses to deep stabilizing muscles, which then contract to anchor the bony ends in the joint, so that the bigger and more powerful muscles can move our limbs, trunk and neck, in a normal fashion.

After prolonged microtrauma, or a more sudden injury to supporting joint ligaments and capsules, these nerve endings are often damaged. Consequently, we lose our ability to stabilize these hypermobile joints. Specific rehabilitation exercises can help increase the strength of the stabilizing muscles. This makes them more sensitive, or responsive to sudden and quick movements, which through a stretch reflex makes them contract, and thereby enables them to stabilize the joint and prevent it from “going too far”.

As the person continues to perform these rehabilitation exercises for at least 6-9 months, it stimulates nerve endings in the joint capsule to grow back, which ultimately results in long lasting increased joint stability and painfree or less painful movements.

In addition to such treatment, postural correction is often essential for people with painful hypermobilities, to help better position the involved joint or joints to reduce tissue strain. As the muscular endurance and strength improves, it becomes easier and less uncomfortable to maintain static positions.

The Olympic games are upon us again, where we undoubtedly will see many athletes with superb joint stability, whether hypermobile or not. Unfortunately, there will likely also be some injuries which will cause joint instabilities that will require either intense rehabilitation afterwards, or even surgery to restore necessary stability.

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